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Wooooo !. Parkinson’s Week quiz time!. Give me 3 causes of gait abnormality:. Parkinson’s disease, Huntington’s disease, Parkinson plus syndromes: Multiple System Atrophy, Lewy Body Dementia, (each of these can produce a short shuffling Parkinson’s gait

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give me 3 causes of gait abnormality
Give me 3 causes of gait abnormality:
  • Parkinson’s disease, Huntington’s disease, Parkinson plus syndromes: Multiple System Atrophy, Lewy Body Dementia, (each of these can produce a short shuffling Parkinson’s gait
  • Huntington’s is more commonly characterised by chorea (brief, purposeless jerky movements)
  • Multiple Sclerosis (tends to be ataxic)
  • Degenerative back, hip and knee joint diseases
  • Trauma (foot, knee, hip, back, head)
  • CVA, multi infarct dementia
  • Infective: encephalitis, meningitis, syphilis
  • Ataxia (ataxic gait) due to ethanol, drugs (egantiepileptics), B12 deficiency, renal failure, sensory ataxia due to spinal lesion or peripheral neuropathy (diabetes), hyper/hypo natremia, hypercalcaemia, cerebellar lesion eg following stroke.
  • Congenital brain abnormality
parkinson s disease
Parkinson’s Disease
  • List one protective and one risk factor for developing Parkinson’s Disease
    • Nicotine Genetics
  • What macroscopic change is evident in this disease?
    • Pallor of the substantianigra
  • State the pathophysiology behind the disease
    • Degen of dopaminergic neurons  ↓ striatal dopamine (putamen responsible for motor) Imbalance of Ach and Dopamine
parkinson s disease1
Parkinson’s Disease
  • How is it diagnosed?
    • Clinical Diagnosis: Must include resting tremor, cogwheel rigidity, bradykinesia/ akinesia and impaired posture. Rule out other causes
  • What are Parkinson Plus Syndromes?
    • Disorders in which there is parkinsonism plus additional features and specific pathology
  • Describe how Levodopa and Carbidopa work
    • Carbidopa – peripheral dopadecaboxylase inhibitor. ↓ req. dose by 10x. Don’t penetrate BBB. Allows levodopa to diffuse across without being decarboxylated
    • Levodopa – Crosses BBB. Decarboxylated into exogenous dopamine floods the synapse
multiple sclerosis
Multiple Sclerosis
  • What is optic neuritis
    • Inflammation of the optic nerve. Sx. due to loss of myelin sheath or, rarely, damage to the axon
  • What brain matter does MS effect?
    • White
  • What defines MS
    • Autoimmune demyelinating disorder characterised by distinct episodes of neurological deficits (separated in time) attributable to white matter lesions (separated in space)
    • symptoms must last for > 24 hr and occur as distinct episodes that are separated by a month or more
multiple sclerosis1
Multiple Sclerosis
  • What are the two main causes of death associated with MS
    • Uraemia and Bronchopneumonia
  • Describe the most common course of MS
    • Relapsing/remitting MS: discrete attacks that evolve over wks-mths. Complete recovery b/n events. If severe (ambulatory) 50% 
  • State some management options for MS
    • Education, rehab, social support, home support….
  • Do steroids have a place in management?
    • Can reduce severity in relapse. No long-term diff
alzheimer disease
Alzheimer Disease
  • State the aetiological difference between delirium and dementia
    • Delirium – disturbed CNS functioning
    • Dementia – Structural CNS pathology
  • What is the DSM IV criteria for dementia
    • A1 – memory impairment
    • A2 - ≥1 cognitive disturbance (aphasia, apraxia, agnosia, executive functioning)
    • B – Disturbances significantly interfere with social and work functions
    • C – Gradual onset and continuing cognitive decline
    • D – Not due to a known organic cause (drugs, illness, CVA)
    • E – Not a delirium
    • F – Not due to another Axis 1 Disorder (eg depression)
alzheimer disease1
Alzheimer Disease
  • How is AD diagnosed?
    • Diagnosis is made on clinical assessment and supported by investigation results.
  • State 3 causes of dementia
    • degenerative cerebral diseases, including
      • Alzheimer's disease (about 60%)
      • dementia of frontal type (up to 10%)
      • dementia with Lewy bodies (up to 10%)
    • vascular (15%)
    • alcohol excess (5%)
    • AIDS dementia
    • cerebral tumours
    • Cruetzfeldt-Jakob disease
    • Pick's disease
    • neurosyphilis
alzheimer disease2
Alzheimer Disease
  • Which three secretases break down APP, and which is the troublesome one?
    • α, β and γ. β is the troublesome one
  • What two elements are involved in the pathogenesis of AD?
    • Aβ peptides which are insoluble and neurotoxic and lead to plaque formation and inflammation
    • Tau protein dysfunction  axon tangles
  • What changes in the brain are observed in AD?
    • Atrophy of the cerebrum, firstly the amygdala and hippocampus.
huntington s disease
Huntington’s Disease
  • What inheritable genetic type is HD? So if both parents have one gene each for the disease, what chance do their kids have of developing it?
    • Autosomal dominant. 75%
  • What macroscopic changes are seen in HD?
    • Atrophy of the caudate nucleus and the putamen
  • How does this explain the Sx of HD?
    • Basal ganglia circuitry dampen (to modulate) motor output. Atrophy  ↑ motor output  chorea
    • Dementia probably due to atrophy of the cortex.
huntington s disease1
Huntington’s Disease
  • Please provide me with a 3D sketch of the caudate nucleus and the putamen, explaining their Function.
  • While you’re at it, do the same for the mammilary bodies
  • What protein is thought to be involved in the pathogenesis of HD? Function?
    • Huntingtin – unknown function
  • What Tx. is available for HD
    • None adequate. Psychosocial, dopamine blocking agents (SE), antidepressants/ anxiety drugs
  • Likely cause of death
    • Infection, suicide
verbally go through a
Verbally go through a….
  • Cranial Nerve Exam
    • I - XII
  • Upper an lower limb neuro exam
    • Position/Function Tests
    • Inspect
    • Tone
    • Strength/Power
    • Reflex
    • Co-ordination
    • Sensation (Soft, pain, vibration, proprioception)